Senators push to open Medicare database

HealthLeadersMedia | Two senators have introduced legislation to overturn a 1979 court injunction that bars the government from revealing what individual physicians earn from Medicare.

That information is stored in the Medicare-claims database, widely considered one of the best tools for finding fraud and abuse in the $500 billion federal health-insurance program for the elderly and disabled.

The Medicare Data Access for Transparency and Accountability Act, or DATA Act, was introduced Thursday by Sens. Ron Wyden (D., Ore.) and Charles Grassley (R., Iowa). They both serve on the Senate Finance Committee, which has jurisdiction over Medicare.

The Wall Street Journal, together with the nonprofit Center for Public Integrity, obtained from the government limited access to the database last year. Despite severe restrictions on using the data, the Journal was able to mine it and publish a series of articles exposing how doctors and other medical practitioners appear to be gaming Medicare to increase revenue.

One physical therapist identified by the Journal as having suspicious billing patterns, Aleksandr Kharkover, was indicted in February on charges of defrauding Medicare. He pleaded not guilty.

The judge who issued the 1979 injunction shielding the data ruled that physicians’ privacy trumped the public’s interest in knowing how tax dollars are spent. He relied on a privacy provision in the Freedom of Information Act, or FOIA. The new bill explicitly exempts physician Medicare billing data from that FOIA provision.

The legislation would also order the Department of Health and Human Services to make the data available at no cost. Patient identities would remain confidential.

Sen. Grassley, in prepared Senate floor remarks, cited articles in the Journal and said the bill “might deter some wasteful practices and overbilling.”

Sen. Wyden, in prepared floor remarks, said “hiding” the data was “indefensible in a free society.”


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